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The nurse is caring for a patient who has sleep deprivation and teaching about the effects that lack of sleep can have on the body. Which of the following information would be included in the teaching plan for this patient?
- A. Decreased insulin resistance
- B. Increased growth hormone
- C. Increased risk of type 2 diabetes
- D. Irritability, moodiness
- E. Increased risk of gastro-esophageal reflux disease (GERD)
Correct Answer: C, D, E
Rationale: Patients with sleep deprivation are at an increased risk of GERD, type 2 diabetes, heart disease, hypertension, and impaired immune function and can also experience cognitive impairment, and behavioural changes such as irritability and moodiness. Sleep deprivation causes an increase in insulin resistance and a decrease in growth hormone.
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The nurse is providing a health-promotion session to young adults who have difficulty sleeping at night and has instructed them to limit their caffeine intake. Which of the following beverages have 50 mg or more of caffeine?
- A. Green tea (237 mL)
- B. Dr. Pepper soda (237 mL)
- C. Chocolate cake (5 cm square)
- D. Brewed coffee (237 mL)
- E. Black tea (237 mL)
Correct Answer: D,E
Rationale: Brewed coffee has 135 mg caffeine and black tea, either leaf or bag, has 50 mg of caffeine. Green tea has 30 mg, chocolate cake has 36 mg, and Dr. Pepper soda has 41 mg.
After the nurse has taught a patient about the use of extended-release zopiclone for insomnia, which patient statement indicates a need for further teaching?
- A. I will take the medication an hour before bedtime.
- B. I should take the medication on an empty stomach.
- C. I should not take this medication unless I can sleep for at least 6 hours.
- D. I will schedule activities that require mental alertness for later in the day.
Correct Answer: A
Rationale: Benzodiazepine receptor agonists such as zopiclone work quickly and should be taken immediately before bedtime, not one hour before. The other patient statements are correct.
Which of these actions should the nurse take first for a patient in the clinic who is complaining of insomnia and daytime fatigue?
- A. Question the patient about the use of over-the-counter (OTC) sleep aids.
- B. Suggest that the patient decrease intake of caffeine-containing beverages.
- C. Advise the patient to get out of bed if unable to fall asleep in 10-20 minutes.
- D. Recommend that the patient use any prescribed sleep aids for only 2-3 weeks.
Correct Answer: A
Rationale: The nurse's first action should be assessment of the patient for factors that may contribute to poor sleep quality or daytime fatigue such as the use of OTC medications. The other actions may be appropriate, but assessment is needed first to choose appropriate interventions to improve the patient's sleep.
Which action is best for the nurse to include in the plan of care in order to improve sleep quality for a critically ill patient in the intensive care unit (ICU)?
- A. Ask all visitors to leave the ICU for the night.
- B. Lower the level of light from 8:00 P.M. until 7:00 A.M.
- C. Avoid the use of opioids for pain relief during the evening hours.
- D. Schedule assessments to allow at least 4 hours of uninterrupted sleep.
Correct Answer: B
Rationale: Lowering the level of light will help mimic normal day/night patterns and maximize the opportunity for sleep. Although frequent assessments and opioid use can disturb sleep patterns, these actions are necessary for the care of critically ill patients. For some patients, having a family member or friend at the bedside may decrease anxiety and improve sleep.
Which action by the nurse manager of an acute care unit will improve the alertness of nurses who work the night shift?
- A. Arrange for older staff members to work most night shifts.
- B. Provide a sleeping area for staff to use for napping at night.
- C. Post reminders about the relationship of sleep and alertness.
- D. Schedule nursing staff to rotate day and night shifts monthly.
Correct Answer: B
Rationale: Short on-site naps will improve alertness. Rotating shifts causes the most disruption in sleep habits. Reminding staff members about the impact of lack of sleep on alertness will not improve sleep or alertness.